Asthma
Asthma
20 Ways to Stop an Attack
"Asthma means twitchy airways," says Peter Creticos, M.D., an allergist and co-director of Johns Hopkins Center for Asthma and Allergic Disease in Baltimore, Maryland. "Your bronchial airways suddenly contract, you feel a tightness in your chest, you become short of breath, and you cough and wheeze."
"In the under-40 age group, probably 90 percent of asthma is triggered by an allergy," says William Ziering, M.D., a Fresno, California, allergist. Tree, weed, and grass pollens, animal dander, dust mites, and mold are the biggest allergic triggers for asthma. (To find out how to control these common allergens, see page 7.) "After age 40, it's about 50 percent. The other 50 percent is triggered by some form of lung disorder such as emphysema."
But no matter what the cause, asthma needn't be a life sentence. You can get your chest problems under control. "Asthma is a reversible disease," says Dr. Ziering. And you don't have to go to the Sahara desert looking for a way to reverse your asthma; there's plenty you can do right at home.
Stay out of smoke-filled rooms. People with asthma shouldn't smoke, but a recent study done in Canada found that people around asthmatics shouldn't smoke either. "This is particularly important in the winter months, when houses are closed up," says Brenda Morrison, Ph.D., a researcher and associate professor at the University of British Columbia, who conducted a study on the effects of cigarette smoking on asthma. "If someone in the house smokes, it leads to a worsening of asthma, especially in children."
Don't light a fire. Throwing another log on the fire, or in the wood stove, will also fuel asthma. "Wood stoves and fireplaces can cause significant trouble for people with asthma," says John Carlson, M.D., an allergist from Virginia Beach, Virginia. If you must make a fire, be sure the wood stove and chimney are airtight in order to reduce the amount of particulates released into your room—and lungs. Also, make sure the room is well ventilated and the fireplace draws well.
Take an antacid at bedtime. Going to sleep on a full stomach might also feed your asthma. "Asthma can be caused by stomach reflux," a condition in which acid backs up into your esophagus from your stomach. "Your stomach contents may leak out a little and drip down into your airway while you're lying down," says Dr. Creticos. "Prop your bed up and elevate the pillow to prevent the dripping, and take an antacid before bedtime to cut down on your stomach's acidity."
Stay out of the deep freeze. You open the front door, step outside, and get hit with a blast of arctic air. What can you do?
"Stay indoors when it's cold outside," says allergist Sidney Friedlaender, M.D., who is clinical professor of medicine at the University of Florida College of Medicine.
Buy a large scarf. If staying indoors isn't possible, however, make sure you keep your mouth and nose covered when going outdoors. "Cold air can trigger asthma, but when you have a scarf or mask covering your mouth and nose, you end up breathing in warm, humid air," says Dr. Friedlaender.
Don't go to Arizona for relief. "A warm, dry climate will help you, but finding the perfect climate isn't as easy as it used to be. The arid area of Arizona was once a haven for asthmatics, but that's not necessarily so anymore," says Dr. Friedlaender. The environment there has changed over the years since urbanization and irrigation. "Now you have things introduced into the air that weren't there 25 years ago, so people who have asthma frequently have as much trouble there, and sometimes even more."
How to Reduce Exercise-Induced Asthma Does your asthma kick in at about the sixth block of your daily jog? When physically working hard, do you suddenly find yourself gasping for air? If you do, you may be experiencing exercise-induced asthma—and you're in some pretty elite company. "At the 1984 Olympics in Los Angeles, fully 20 percent of the Olympians suffered with it," says William Ziering, M.D. "In the general population now, one in ten people is thought to have it." And you're that one. Lucky you. Here's what Dr. Ziering recommends you do. Open your stride, not your mouth. When you open your mouth to gasp for air when exercising hard, you're drying the back of your throat and it becomes cool, which triggers your asthma. Keep your mouth closed and breathe through your nose. Swim to dampen your asthma. Swimming is the ideal exercise for asthmatics, says Dr. Ziering. Because of the high humidity, your mouth won't dry out. "But any sport that requires shorter bursts of exercise, such as baseball, tennis, and golf, is good." Give yourself a breather. If you run like a deer, you're going to wear out fast. Asthmatics need to pace themselves. "Take the time to warm up, and then start out slow," he says. Pack your asthma medicine in your gym bag. Use it before you suit up. "If you take your medicine 15 minutes before activity, you should be all right," he says. And all you future Olympians needn't worry. Your asthma medication is sanctioned by the Olympic committee. |
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If you still want to move, he suggests looking for a warm, dry climate in an area that is fairly undeveloped. Then vacation there for a couple of weeks to see how your asthma—and you—can handle it.
Use auto air conditioning wisely. Air conditioning may be good for asthmatics but not if it's bringing the outside air in, warns allergist Norman Richard, M.D., a clinical assistant professor at the State University of New York at Buffalo School of Medicine and Biomedical Sciences. "Don't run the car's air conditioning on the setting that draws in outside air and cools it," he says. "Outside air brings with it pollen, and cool, pollinated air is bad for asthma. Set your air conditioner on the recirculate or maximum setting, which won't bring in pollen."
Watch what you eat. Eating the wrong foods could be the right recipe for an asthma attack. "Some of the most common types of foods that trigger asthma are milk, eggs, nuts, and seafood," says Dr. Carlson. If you're asthmatic, learn which foods can trigger an attack and avoid them.
Stay out of the kitchen. Even smelling the foods you're sensitive to can bring on an attack, says Dr. Carlson. In a study, he discovered that just a whiff of eggs frying in the pan was enough to bring on asthma attacks in a couple of his patients. "You don't have to eat the foods to be affected. Just the aroma of the food could bring on asthma in some people."
Be salt sensible. In a study conducted at the Department of Community Medicine of St. Thomas Hospital in London, researchers discovered that table salt could have a life-threatening effect on your asthma. "A strong correlation was found between table salt purchases and asthma mortality in both men and children," reported the researchers. Buying the salt wasn't killing people; eating it was.
Beware of food additives. "Food additives, especially metabisulfite and possibly MSG [monosodium glutamate], can trigger asthma," says allergist William Busse, M.D., professor of medicine at the University of Wisconsin Medical School. "Most commonly metabisulfite is found in beer wine, shrimp, and dried fruits, particularly apricots."
Sulfites also used to be sprinkled on fruits and vegetables on salad bars to keep them looking fresh, but that practice has been banned. The best advice, according to Dr. Busse, "is to be aware of the kinds of foods sulfites are in and avoid them. When eating out, ask if MSG or metabisulfite is added to the food, and if so, request it be left out of your meal."
MEDICAL ALERT
Take New Symptoms Seriously Asthma is nothing to wheeze at. Every year more than 4,000 people die from it. In fact, in the past few years, the death rate from asthma has gone up 23 percent. "The mortality rate increases every year," says William Ziering, M.D., "which is sad because asthma is a reversible condition. Nobody should die from asthma." But they do. Why is this phenomenon taking place? "One, patients don't realize the severity of the condition," he says. "Other times they let themselves run out of medicine, or they try riding out the serious attack and don't seek medical attention before it's too late." How do you know when you need help? "Typically, if you realize your asthma is increasing and you begin to use your medicines more frequently than normal," says Peter Creticos, M.D. "For instance, if you were normally taking one or two puffs of your inhaler a week but are now taking three or four or more puffs a day, that's a good sign that you should see your doctor. Frequency of use of medications is what to watch for," he says. Also, the experts warn that you should seek immediate medical attention anytime you're having difficulty breathing. |
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Use nonaspirin pain relievers. In medical terms, it's known as the "aspirin triad," and it consists of sinusitis/nasal polyps, asthma, and a sensitivity to aspirin. For some asthmatics, taking aspirin could have life-threatening consequences. "If you have sinusitis and nasal polyps and asthma, I wouldn't recommend any nonsteroidal anti-inflammatory like aspirin or ibuprofen because it could make your asthma worse or even kill you," says allergist Richard Lockey, M.D., director of the Division of Allergy and Immunology at the University of South Florida College of Medicine, who studied the link.
This aspirin sensitivity could just suddenly develop, so it's best to stay clear of aspirin products altogether, says Dr. Friedlaender. "The problem doesn't happen when you use acetaminophen," he says.
Use inhalers correctly. An inhaler, whether prescribed by a physician or bought over the counter, can bring quick relief to an asthmatic under attack—provided it is used correctly.
"Your inhaler isn't a breath freshener. Don't spray it on the back of your throat because it won't get into your lungs that way," says Michael Sherman, M.D., a pulmonologist at Hahnemann University Hospital in Philadelphia, Pennsylvania. "If you see the mist coming out of your mouth, you're using it wrong."
Sticking the inhaler in your mouth and taking a couple of quick hits isn't the thing to do, either. "Hold the inhaler about an inch away from your open mouth, take a slow deep breath, and just after you start breathing in—about a half second or so—depress the inhaler. Continue to breathe in after spraying and then hold your breath for 3 to 5 seconds.
"Your first puff opens up the airway, but if you take two quick puffs right away, the second puff doesn't add anything. If you wait 2 to 5 minutes, then the second puff will be of added benefit."
Count on caffeine in a pinch. You're out in the wilderness and suddenly realize that you left your inhaler at home. What do you do if you feel an attack coming on? Head for the coffee pot. "A couple of cups of strong coffee will have a beneficial effect on asthma," says allergist Allan Becker, M.D., assistant professor of medicine at the University of Manitoba, who tested the effects of caffeine on asthma.
Asthmatics given pills that contained the amount of caffeine found in two cups of coffee "could breathe better and their asthma improved," Dr. Becker found. Caffeine and the popular asthma drug Theophylline are almost identical—your body doesn't know the difference.
He cautions, however, that caffeine is not a substitute for your medication. "We don't recommend it as a treatment, but in an emergency, when you don't have your medication around, two strong cups of coffee or hot cocoa or a couple of chocolate bars would be an effective substitute medication that would buy time until you could get to your medicine or inhaler."
Enlist B6 in the battle. Knowledge of the effectiveness of vitamin B6 on asthma came about by accident. When researchers were studying the effects of the vitamin on those with sickle-cell anemia, they discovered that some members of the non-sickle-cell group also had a history of asthma. "When they took 50 milligrams of B6 daily, it reduced the severity of their asthma attacks," says internist Clayton L. Natta, M.D., associate professor of medicine at Columbia University College of Physicians and Surgeons, who conducted the research. "Further study of asthmatics supported the effectiveness of B6" adds Dr. Natta.
Megadoses of vitamin B6 can be toxic and are not recommended, but Dr. Natta says for an adult, "50 milligrams is a safe dose that is given medically all the time." (For complete safety, use B6 only with the approval and supervision of your doctor.)
Listen to your lungs. Of course, the best way to fight an asthma attack is to not have one in the first place. "Recognize your own pattern," says Dr. Ziering. "Be aware of what your early signs of asthma are. When you see the warning signals and you act right away, you will be able to ward it off.
"You don't suddenly have severe asthma," he notes. "That's rare. There is typically a pattern, and you can intervene in that process and stop it in its tracks." The earlier you act, the less severe the asthma will be.
PANEL OF ADVISERS
Allan Becker, M.D., is an allergist and assistant professor of medicine in the Section of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, at the University of Manitoba in Winnipeg. He has done research on the effects of caffeine on asthma.
William Busse, M.D., is an allergist in private practice and a professor of medicine at the University of Wisconsin Medical School in Madison.
John Carlson, M.D., is an allergist in private practice in Virginia Beach, Virginia.
Peter Creticos, M.D., is an allergist and co-director of Johns Hopkins Center for Asthma and Allergic Disease in Baltimore, Maryland. He is also assistant professor of medicine at Johns Hopkins University School of Medicine.
Sidney Friedlaender, M.D., is an allergist and clinical professor of medicine at the University of Florida College of Medicine in Gainesville. He is also editor in chief of Immunology and Allergy Practice, a professional journal.
Richard Lockey, M.D., is an allergist and director of the Division of Allergy and Immunology at the University of South Florida College of Medicine in Tampa.
Brenda Morrison, Ph.D., is an epidemiologist, biostatistician, and associate professor in the Department of Health Care and Epidemiology at the University of British Columbia in Vancouver. She has done research on the effects of smoking on asthma.
Clayton L. Natta, M.D., is an internist and associate professor of medicine at Columbia University College of Physicians and Surgeons in New York City.
Norman Richard, M.D., is an allergist and clinical assistant professor of pediatrics at the State University of New York at Buffalo School of Medicine and Biomedical Sciences.
Michael Sherman, M.D., is a pulmonologist in the Division of Pulmonary Medicine at Hahnemann University Hospital in Philadelphia, Pennsylvania.
William Ziering, M.D., is an allergist in private practice in Fresno, California.
